I was reading the paper this morning, and this topic was mentioned in teh "Ask Marilyn" column. The question and answer was this
"A question has been bothering me since I moved to a city that is home to some of the finest hospitals in the world. When I use public transportation, I see people wearing scrub suits to work. Is this acceptable? I had thought employees were supposed to change into scrubs provided at the hospital in order to leave outside germs at the door"-
and her answer
"You're right. I've noticed the same phenomenon in other cities, too. If those people are hospital employees they are endangering patients and should be reported to hospital authorities. Another growing problem is scrubs being stolen and word in other places, such as the subway, to convey an impression of respectability. Anyone seen wearing scrubs outside an appropriate environment should be regarded with caution"
What do you think?
WHen i was a student, so recently, we had to wear our scrubs into the hospital, we were told not to change at the hospital. Here I saw the OB nurses and OR nurses were the only ones who had uniforms provided to them to change into at the hospital.
...despite the information you have shared, most hospitals won't go to such lengths to prevent these infections. it wouldn't be cost effective for them to create a space for staff to change from street clothes to scrubs... additionally, the cost of providing scrubs to staff and washing them would be prohibitive to most facilities, especially public ones that have a higher percentage of patients who are unable to pay for their care.
a fair point... unless it can be proven otherwise...
it has been suggested that approximately one in ten patients admitted to hospital suffer from one or more hais at any one time (dh/phls, 1988).
plowman et al (2001), estimated that hais cost the nhs £986.36 million a year...
most of this cost, £930.62 million was borne by in-patient services, and £55.74 million by non-acute services, of which general practitioners costs were valued at £8.49 million, hospital out-patients departments £26.83 million and district nursing services £20.51 million.
now i don't have the figures for the usa, but if hais cost the uk this much, and providing adequate changes of clothing and washing facilities should reduce this figure, you could find yourself saving money... i stress the could part here because there is no research into how much it would cost the nhs to provide adequate changing facilities (presumably more of a one off cost to convert existing facilities and rooms with maybe the odd layout to keep them clean and servicable) and adequate uniform provision (presumably a regular expenditure), so i can't perform a cost-benifit analysis... still... the potential is intriguing
First off...the number one cause of HAI's is improper or lack of handwashing...not employee uniforms. If stating that "caution" should be of concern to us..then we mat-as-well quarantine any person visiting a family member...street clothes coming into a hospital. I understand the fact that they are not dealing with many patients...but dang..I have worked in an OR and ER and I seriously cannot remember a time where my uniform was involved with bodily fluids.
IF you have a pt. requiring drsg changes that create splash you are to wear appropriate attire, hence an isolation gown and what not. During surgery a person in contact with the pt. or his/her fluids is generally or should be in a sterile gown, hence not coming on contact with uniform. I know as a circulator, there were surgeries or surgeons for that matter that I put on a gown, cause they were messy.
I honestly believe that health care companies, hospitals and clinics should provide uniforms or pay a clothing allowance...that is the proper thing to do however we all know it won't happen.
I am sure there are plenty of cases of nurses/healthcare proffessionals leaving a facility going into the general public with soils on his/her uniform, unfort. it is a reality.
Sometimes, I actually leave for work with my sethoscope and nametag on and don't realize it till I get alot of weird looks, lol...hey I am busy and working hard. The fact of the matter is, I am a nurse...it is part of my life and it is part of who I am...I don't always have time to go home or change at work...I don't even have kids!!! Can't imagine what that would be like, congrats to all parents on that one.
The response to that womens letter was ridiculous...I would bet my life that if you tested healthcare proffesional's hands and the general public, the hands of the general public will be much worse...but hell lets all live in a bubble.
I have noticed this trend here in New Zealand too.
I worked in an Obstetric OR and we had the crazy problem of keeping some staff [mainly midwives] out of the OR in their mufti for routine elective surgery!
Everyone is becoming more & more blase about adhering to rules.
So it makes it harder to enforce them.
You are viewed as some sort of Control Freak.
However, most Public hospitals in New Zealand still provide the nurses with their uniforms.
As far as HAIs go: I get annoyed at the fact that where I work, the emphasis is only on the nurses to wash their hands.
Sometimes doctors get targeted too. But the support staff, such as orderlies, & anaesthetic technicians who help with all sorts of tasks that include touching patients seem to have no monitoring at all.GRRRR!
I was reading the paper this morning, and this topic was mentioned in teh "Ask Marilyn" column. The question and answer was this
"A question has been bothering me since I moved to a city that is home to some of the finest hospitals in the world. When I use public transportation, I see people wearing scrub suits to work. Is this acceptable? I had thought employees were supposed to change into scrubs provided at the hospital in order to leave outside germs at the door"-
and her answer
"You're right. I've noticed the same phenomenon in other cities, too. If those people are hospital employees they are endangering patients and should be reported to hospital authorities. Another growing problem is scrubs being stolen and word in other places, such as the subway, to convey an impression of respectability. Anyone seen wearing scrubs outside an appropriate environment should be regarded with caution"
What do you think?
WHen i was a student, so recently, we had to wear our scrubs into the hospital, we were told not to change at the hospital. Here I saw the OB nurses and OR nurses were the only ones who had uniforms provided to them to change into at the hospital.
Scrubs now are worn as regular nurses uniforms. The OR and OB nurses still have to change when they come to work and their scrubs are provided to them by the facility they work at.
Scrubs are worn as nursing uniforms now. Most facilities allow this as part of the dress code. OB and OR nurses still have to change when they arrive at work and their scrubs are provided by the facility.
I just wonder.... Do these people not know that they are surrounded by germs everyday? Perhaps they would like everyone to be "decontaminated" before entering into public. The same people I take care of, were out using public transportation, shopping at the store, or attending their church before being admitted into the hospital. WASH YOUR HANDS... I were my srubs to work, but I do change my shoes before I get in my car. A little common sense goes a long way.
Ditto. I finally got an e-mail to go through. Wrote to the editor of Parade as well. I rec'd an automated reply from the editor. Nothing from Marilyn. I think I may well skip her column from here on out.
I was reading the paper this morning, and this topic was mentioned in teh "Ask Marilyn" column. The question and answer was this
"A question has been bothering me since I moved to a city that is home to some of the finest hospitals in the world. When I use public transportation, I see people wearing scrub suits to work. Is this acceptable? I had thought employees were supposed to change into scrubs provided at the hospital in order to leave outside germs at the door"-
and her answer
"You're right. I've noticed the same phenomenon in other cities, too. If those people are hospital employees they are endangering patients and should be reported to hospital authorities. Another growing problem is scrubs being stolen and word in other places, such as the subway, to convey an impression of respectability. Anyone seen wearing scrubs outside an appropriate environment should be regarded with caution"
What do you think?
WHen i was a student, so recently, we had to wear our scrubs into the hospital, we were told not to change at the hospital. Here I saw the OB nurses and OR nurses were the only ones who had uniforms provided to them to change into at the hospital.
Honestly, I dont think the question should be whether we should wear scrubs in public or not but the question should be "Why does Marilyn have a job answering questions from people with too much time on their hands and does (most likely) zip research before she answers them."
I too spray my shoes. I can't stand to see people at the store in their scrubs! I won't even let my kids go near my scrubs until they are washed and clean. We have 3 cases of C Diff on our floor right now. They didn't come to the hospital with it, but now they have it. I wonder how that happened...
A couple of times a week I spray workshoes with Lysol. I doo my regular shoes too, but that's because I have stinky feet. :)
When I road the train, when I lived in Atlanta, I didn't know what the next guy had. How many times do people cough on trains. Did everyone who touched the seat I'm in thorouglhly wash their hands?
I'm sure if nurses passing along deadly or germs that make people sick was a big problem we'd know about it by now.
I was reading the paper this morning, and this topic was mentioned in teh "Ask Marilyn" column. The question and answer was this
"A question has been bothering me since I moved to a city that is home to some of the finest hospitals in the world. When I use public transportation, I see people wearing scrub suits to work. Is this acceptable? I had thought employees were supposed to change into scrubs provided at the hospital in order to leave outside germs at the door"-
and her answer
"You're right. I've noticed the same phenomenon in other cities, too. If those people are hospital employees they are endangering patients and should be reported to hospital authorities. Another growing problem is scrubs being stolen and word in other places, such as the subway, to convey an impression of respectability. Anyone seen wearing scrubs outside an appropriate environment should be regarded with caution"
What do you think?
WHen i was a student, so recently, we had to wear our scrubs into the hospital, we were told not to change at the hospital. Here I saw the OB nurses and OR nurses were the only ones who had uniforms provided to them to change into at the hospital.
Regarding wearing scrubs in public,Nurses and Doctors are not the only ones who wear scrubs.What about personel in House keeping,pharmacy,doctors offices,veternary techs.vets.dental hygenist,medical students, and some others that I have seen.I agree that those working in ICU/OR/LD,ect, should change if they are leaving their departments or going out side for any length of time.The contagious issue?ever been in a big city indigent care facility waiting room?I think it is a moot point considering what comes and goes in there.my2cents,James
we have 3 cases of c diff on our floor right now. they didn't come to the hospital with it, but now they have it. i wonder how that happened...
bearing in mind we all have clostridium difficile as part of our normal intestinal flora, it is just possible that if these patients were on antibiotics they are isolated cases and not related. the infection is usually assocated with 14 days or more of antibiotic useage preceeding the development of diarrhoea (antibiotics alter the normal flora of the bowel, which allow clostridium difficile to reproduce).
however... it is more likley that, as a unique property of c-diff is spore formation, they have been cross-contaminated by someone's lax standard of hygine and standard isolation practices. a patient having diarrhoea secondary to c-diff may heavily contaminate his environment with microscopic spores, including the uniform of health staff...
this is an extract taken from the 'nursing standard' one of the major weekly uk nursing publications...
"... healthcare staff uniforms are frequently contaminated by disease-causing bacteria, including staphylococcus aureus, clostridium difficile and glycopeptide-resistant enterococci (gre), presenting a potential source of crossinfection in the clinical setting (babb et al 1983, perry et al 2001, speers et al 1969). maximum contamination occurs in areas of greatest hand contact, that is, pockets, cuffs and aprons (babb et al 1983, loh et al 2000, wong et al 1991), allowing re-contamination of washed hands..."
now, while hand hygiene is now well recognised as the single most important factor in the prevention of cross-infection, contact transfer of bacteria from uniforms leading to infection has also been described (hambraeus 1973, hambraeus and ransjo 1977), yet seems to be an issue that so many are resitant to... and i have no idea why when there is a rapidly growing mountain of evidence around clothing contamination.
in a study which demonstrated that contamination of uniforms might be a significant contributory factor to the spread of nosocomial infection, callaghan (1998) highlighted the widespread problem of inadequate provision of uniforms and laundering facilities in hospitals. this resulted in many staff travelling to and from work in uniforms which they laundered themselves in a domestic washing machine.
following a major outbreak of salmonella infection at the victoria infirmary, glasgow, in december 2001 and january 2002, the watt group report (scottish executive 2002) raised concerns about the trust's uniform policy, and recommended that: 'every trust should have a staff uniform policy that ensures:
all staff uniforms are laundered by, or under the auspices of, the nhs.
the widespread practice of staff travelling to and from work in (potentially contaminated) uniforms ceases.
adequate staff changing and decontamination facilities are provided.'
as an aside, public concerns about the role of staff uniforms in the spread of infection have been voiced by a number of speakers in a recent parliamentary debate on hospital-acquired infection (house of commons 2004).
where an employer requires staff to wear uniform, callaghan (1998) recommended that the number provided should be sufficient to allow a change of uniform per shift, taking into account turnaround times for laundering and delivery. for nurses, she suggests that not less than nine uniforms be provided. the responses received from trusts that required uniforms to be worn show that 43 per cent provide only three or four uniforms per nurse, making it difficult to change daily or if the uniform becomes grossly contaminated. however, 86 per cent of trusts expect nurses to change uniforms on a daily basis.
only 26 per cent of trusts had adequate onsite changing facilities; the rest being insufficient or absent. in both the watt group report (scottish executive 2002) and callaghan's (1998) study, lack of changing facilities meant that staff were obliged to travel to and from work in potentially contaminated uniforms or change in unsuitable places, for example, toilets. this is despite the fact that the workplace (health, safety and welfare) regulations (1992) require that changing facilities, including lockers and showers, be provided for staff and that current nhs estates (2003) guidance on infection control in the built environment states that:
"changing facilities should be provided for all staff, to encourage them to change out of their uniforms in the workplace..."
few trusts provided on-site laundry services and turnaround times, regardless of site, were inadequate. however, it was a surprise to find that almost two-thirds provided no laundry facilities for nursing staff. when combined with the finding that, in a further 26 per cent of trusts, nurses did not feel able to use a service they perceived as inadequate, it appears that around 90 per cent of healthcare staff have to take responsibility for the cleanliness of their uniforms. this implies that it is usual for staff to travel to and from work either wearing or carrying potentially contaminated clothing. the fact that more than half of the trusts questioned did not condone off-site wearing of uniform can make little difference to practice, as most staff have no suitable place to change.
despite publication of the nhs executive (1995) guidance for the laundering of healthcare linen and callaghan's (1998) more specific guidance, few trusts provided appropriate guidance for staff on handling and home washing of uniforms. some instructions were spurious, unhelpful or wrong. it is worth noting, however, that even if home laundering guidance followed that favoured by callaghan (1998a), it would be impossible to assure the quality of the processes undertaken by staff in their own homes.
the potential for cross-contamination and spread of organisms such as methicillinresistant staphylococcus aureus (mrsa) and c-diff within healthcare facilities, the homes of staff and the community is clear. despite the mounting evidence there seems to be a large number of health care providers, not just nurses, that don't see the risks for whatever reason.
now i will agree the the current situation does not support healthcare staff in following best practice. minimum standards for uniform provision, changing facilities and laundering need to be agreed and introduced as a matter of urgency, to support current initiatives in the prevention of health-care-associated-infections.
the most important aspect though is to educate all those who insist on continuing with practices that put their patients and the wider community at risk...
now before i get a backlash of uproar to question various members of this site's practices, i will attempt to re-address some of the points made...
visitors are just as resonsbile for hygine in hospitals as staff...
i agree that visitors should shoulder some of the responsibility for ensuring that hospitals are a safe environment, but in order to do that they need education and support from health care staff. they should be educated in standard isolation practices (handwashing and use of ppc) when necessary, and these practices should be enforced by the nurses rigidly. it may mean we look like the bad-guys if we dont explain it properly and at a level our patients and their relatives can understand... but id rather spend time doing that than have to tell my patient they have contracted mrsa or c-diff
it is not just nurses who are responsible for this issue...
again i totally agree... doctors, physios, ots, radiographers, domestics... everyone in employed by a health care organisation is responsible... but nurses are the visible face of healthcare and as such an easy target... but change has to start somewhere and we should be leading by example... at the moment we seem to be saying "hey its not just us you should be blaming"... instead we should be able to say "i know my practice is safe, we are just waiting for everyone else to catch up with nurses!
there are not enough changing facilities or uniforms/scrubs are not provided
i agree again... but if enough of us get it together, we can force change on the system. it wont be easy... but is is necessary.
the evidence is here... all we have to do now is act on it!
Spidey's mom, ADN, BSN, RN
11,305 Posts
I wrote to her . . . haven't heard anything back.
steph